Malaria

Question 1

Most common and most severe type of malaria

Answer 1

Falciparum

Question 2

Features of severe malaria

Answer 2

schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia

Question 3

Parasitaemia over what % means severe malaria?

Answer 3

> 2%

Question 4

Complications of severe malaria

Answer 4

• cerebral malaria: seizures, coma
• renal failure: blackwater fever, (intravascular haemolysis)
• ARDS
• hypoglycaemia
• disseminated intravascular coagulation (DIC)

Question 5

Treatment of uncomplicated falciparum malaria

Answer 5

artemisinin-based combination therapies (ACTs)
- artemether
+ lumefantrine
+ amodiaquine
+ mefloquine
+ sulfadoxine-pyrimethamine,
- dihydroartemisinin plus piperaquine

Question 6

Treatment of complicated falciparum malaria

Answer 6

parenteral drugs
consider exchange transfusion if parasitaemia >10%

Question 7

A parasite count over what percentage should prompt exchange transfusion?

Answer 7

parasite count > 10%

Question 8

Gold standard diagnostic investigation for malaria?

Answer 8

Blood film

Question 9

What is the difference between a thick and thin blood film?

Answer 9

thick: more sensitive

thin: determines species

Question 10

What rapid diagnostic test can be used to look for malaria

Answer 10

detection of plasmodial histidine-rich protein 2

Question 11

Signs of malaria on FBC

Answer 11

thrombocythaemia
normochromic normocytic anaemia
normal white cell count
reticulocytosis

Question 12

Causes of non-falciparum malaria

Answer 12

Plasmodium vivax (most common)
Plasmodium ovale
Plasmodium malariae

Question 13

Where are the non-falciparum malaria species commonly found?

Answer 13

Plasmodium vivax
- Central America and the Indian Subcontinent

Plasmodium ovale - Africa.

Question 14

Features of non-falciparum malaria

Answer 14

• fever (every 48/72 hrs)
• headache
• splenomegaly
• Plasmodium malariae is associated with nephrotic syndrome.

Question 15

Why do plasmodium ovale/vivax often relapse after treatment?

Answer 15

they have a hypnozoite stage

**patients should be given primaquine following acute treatment with chloroquine to destroy liver hypnozoites and prevent relapse

Question 16

Treatment of non-falciparum malaria

Answer 16

• artemisinin-based combination therapy (ACT) or chloroquine (if not resistant)

Question 17

In what patient group should ACT treatment be avoided?

Answer 17

ACTs should be avoided in pregnant women

Question 18

When should Atovaquone + proguanil (Malarone) be taken as prophylaxis?

Answer 18

1 - 2 days before travel,
until 7 days after travel

Question 19

Main side effect of Atovaquone + proguanil (Malarone)

Answer 19

GI upset

Question 20

For how long should chloroquine be taken as malaria prophylaxis?

Answer 20

1 week before, until
4 weeks after

Taken ONCE WEEKLY

Question 21

Chloroquine side effects and contraindications

Answer 21

headache

C/I in epilepsy

Question 22

For how long should doxycycline be taken as prophylaxis?

Answer 22

1-2 days before travel until 4 weeks after

Question 23

Doxycycline side effects

Answer 23

photosensitivity
oesophagitis

Question 24

For how long should Mefloquine (Lariam) be taken as malaria prophylaxis?

Answer 24

2-3 weeks prior to travel, until 4 weeeks after

**Taken ONCE WEEKLY

Question 25

Side effects and contraindications of Mefloquine (Lariam)?

Answer 25

Dizziness
Neuropsychiatric disturbance

C/I in epilepy

Question 26

For how long should Proguanil (Paludrine) or Proguanil + chloroquinebe taken as malaria prophylaxis?

Answer 26

From 1 week prior to travel, until 4 weeks after

Question 27

Why may parasites not be detected on blood films in pregnant patients?

Answer 27

Placental sequestration

Question 28

Malaria prophylaxis in pregnancy

Answer 28

• ideally don’t travel to malaria endemic area
• chloroquine
• Folate supplementation

Question 29

Malaria prophylaxis in children

Answer 29

• diethyltoluamide (DEET) 20-50% (used children >2 months)
• doxycycline if >12 years